Connection in the Time of Covid
As we scramble to adjust to our “new normal” we are faced with unique challenges every day. We were a few weeks into our virtual program, running our Intensive Outpatient Program via Zoom when one of our group members ran into difficulties. We were in our Morning Check-in, around 9:15 AM. Normally an articulate, polite and proper woman she was slurring her words, holding her head up with her hands and, interrupting and talking over people. A flurry of texts ensued on cell phones between group members and group members and staff. We all concurred that she had been drinking and needed to step away from the group. When she signed on that morning she had disclosed to us that earlier that morning she had a difficult interaction with another family member that upset her. Staff conferred quickly via text and it was decided that the Program Manager, the most experienced of the clinicians would try to reach the woman by phone.
The Program Manager is me. I had only met this woman once or twice before the quarantine and although we had conversed in Zoom groups we don’t know each other very well. Our previous interactions had been cordial however so I felt it was worth a shot. I wasn’t sure she would even pick up the phone and was surprised when she did. I identified myself and she seemed relieved that I called. I told her that everyone was worried about her as she just didn’t seem herself this morning. She agreed that she was very upset about the experience she had earlier that morning. I then asked her if she had been drinking, fully expecting her to hang up on me. Instead, she tearfully told me that yes she had been drinking since early that morning. I told her that normally when someone comes to a group under the influence we ask them to leave the group until the alcohol is out of their system and then return to the group. I asked her if she could sign off from the group for now and stay on the phone with me. She agreed. Again I was surprised. We spoke for a while, she telling me how ashamed she felt and how she felt she had failed and me offering reassurances that relapses were part of the process and we could help her get back on track. She also talked about how isolated she felt-a problem she had been working on before Covid-19 and now magnified by our stay at home orders. I then asked her what she was drinking and if she had any left. She admitted that she had some wine left in the bottle. My graduate school education was excellent but didn’t cover Telehealth interventions so I thought about what to do next. This time I surprised myself. I asked her if she was ready to do something and she could tell me no if she wasn’t ready. “OK” she responded, sounding curious. I asked her to take the bottle and me, on the phone into the kitchen and dump the rest of the wine down the sink. Again I expected her to hang up on me but I heard her walk into the kitchen and tell me she was pouring the wine into the sink. Since I couldn’t see what she was doing, she could have been pouring a bottle of milk into the sink but it sounded like wine to me so I went along. She then told me, somewhat enthusiastically that she was going to get rid of the bottle too. It sounded like she walked into the garage and put it in a recycling bin, with other bottles. She actually sounded relieved that I had help her do this. I asked if there was any more alcohol in the house and she told me no. After a little more discussion, she decided she wanted to reach out to a close family member and speak with them by phone. I told her that I would see her in the Zoom group the next morning. We signed off and although I worried about her the rest of the day I was relieved to see her back in the group the next morning, clear headed and ready to continue her recovery work.
As clinicians in a virtual environment we don’t have a lot of the usual tools to work with. Often, when in person we can smell if someone has been drinking. If someone walked into a group with a coffee mug we would be able to tell if it is filled with coffee or vodka. Now, lot’s of people are in their Zoom group with a coffee mug and we don’t know what is in it. Our voices are not the same conveyed over electronics compared to the warmth we can convey in person. With shelter in place orders (We are in Massachusetts, close to one of the virus epicenters) we cannot use the labs for drug screens. All we can do for now is try to stay connected electronically. Many treatment programs have gone virtual and most of the self help groups have as well. The antidote to addiction is connection (Johan Hari). For now we just have to connect through our screens.